Randomized controlled study comparing simultaneous modulated accelerated radiotherapy versus simultaneous integrated boost intensity modulated radiotherapy in the treatment of locally advanced head and neck cancer

Tandon, Sarthak; Gairola, Munish; Ahlawat, Parveen; Rawat, Sheh; Aggarwal, Archana; Sharma, Kanika; Tiwari, Sandeep; Karimi, Ahmad Masroor; Muttagi, V.; Sachdeva, N.; Bhushan, Manindra

doi:10.1016/j.jnci.2018.06.001

Cited by 2 publications

(7 citation statements)

References 35 publications

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“…26 The anticipated incidence of grade ¾ mucositis 69% is with conventional chemoradiotherapy versus 89% in the accelerated radiotherapy protocols with a p -value of 0.0001. 15 26 27 In the current study, treatment was well tolerated in both arms. The only observed difference was in the pattern of onset and resolution of the grade 3 mucositis.…”

Section: Discussionmentioning

confidence: 64%

“…The pivotal study of “SMART-SIB” had observed a surprising increase in fatigue in the conventional arm compared with the “SMART” arm (66.6 vs. 40%) and was statistically significant with a p -value of 0.038. 15 However, the authors did not offer a scientific rationale for the same. Newer studies are evaluating the correlation of brainstem especially the medullary doses toward the continuation of fatigue.…”

Section: Discussionmentioning

confidence: 99%

“…In an earlier similar study done by Tandon et al (where they had compared similar dose per fractionations), a range of BEDs was calculated for each arm, according to the time of initiation of accelerated repopulation. 15 The range of BEDs was 65.9 to 76.2Gy 10 and 66.1 to 73Gy 10 for the control and study arms, respectively. 15 We, therefore, concluded that the two fractionation schedules used could be considered as having a similar BED for the tumor tissue.…”

Section: Introductionmentioning

confidence: 90%

“…15 The range of BEDs was 65.9 to 76.2Gy 10 and 66.1 to 73Gy 10 for the control and study arms, respectively. 15 We, therefore, concluded that the two fractionation schedules used could be considered as having a similar BED for the tumor tissue.…”

Section: Introductionmentioning

confidence: 90%

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Simultaneous Modulated Accelerated Radiotherapy (SMART) with Dysphagia Aspiration-Related Structures (DARS) Sparing: Do We Have a Role for Dose Condensation in Locally Advanced Head and Neck Cancer

Joseph

Ramachandran

Valuvil

et al. 2022

ASJO

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Introduction Concurrent chemotherapy integrated with intensity-modulated radiotherapy (IMRT) is the standard of care for locally advanced head and neck cancer. Simultaneous integrated boost technique has allowed differential doses to primary and normal structures permitting significant toxicity reduction. The current study explores the feasibility of the simultaneous modulated accelerated radiotherapy (SMART) technique to enhance cytoreduction and explore the possibility of dose intensification with radiobiologically targeted treatment condensation. Methods Thirty patients were randomized in an open-labeled study to receive concurrent chemoradiation of 60 Gy in 25 fractions with “SMART” technique or 70 Gy in 35 fractions using conventional intensity-modulated radiotherapy simultaneous integrated boost “IMRT SIB.” The primary endpoints included comparative volumetric cytoreduction between the study and control arm assessed during the course of treatment and final response evaluation. Secondary endpoints involved the assessment of acute toxicity parameters for xerostomia, mucositis, dysphagia, and fatigue. Results The “SMART” study arm showed comparable volumetric cytoreduction to the conventional “IMRT SIB” arm at midtreatment (p-value = 0.225) as well as toward completion (p-value = 0.476). The study arm did observe 94.4% cytoreduction of tumor volume compared with 88.05% in the conventional arm at the time of response evaluation. In spite of treatment condensation, there was no significant increase in toxicity with “SMART.” There was no difference in the frequency or duration of grade 3 mucositis in the “SMART” arm in spite of intensification (p-value = 0.728). In the “SMART” arm, there was a favorable reduction in the duration of grade ⅔ dysphagia; 2.8 weeks versus 4.6 weeks (p-value = 0.002). Even though the xerostomia was comparable in frequency and intensity, the total duration of xerostomia was 50% less (p-value = 0.001). Conclusions The “SMART” technique provides a radiobiologically sound, effective, and safe protocol that has the potential to improve the treatment of locally advanced head and neck cancer. The good tolerability and toxicity profile in the study arm is encouraging and facilitates further research.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 90%

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Simultaneous Modulated Accelerated Radiotherapy (SMART) with Dysphagia Aspiration-Related Structures (DARS) Sparing: Do We Have a Role for Dose Condensation in Locally Advanced Head and Neck Cancer

Joseph

Ramachandran

Valuvil

et al. 2022

ASJO

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“…In terms of IMRT techniques, one RCT 78 (N 5 122) compared sequential versus simultaneous integrated boost IMRT in patients with nasopharyngeal carcinoma, showing similar outcomes in terms of acute adverse events and toxicities for the two techniques. An RCT 80 (N 5 60) comparing simultaneous modulated accelerated radiation therapy versus simultaneous integrated boost IMRT in the treatment of locally advanced head and neck cancer demonstrated similar adverse outcomes.…”

Section: Literature Review and Analysismentioning

confidence: 98%

Salivary Gland Hypofunction and/or Xerostomia Induced by Nonsurgical Cancer Therapies: ISOO/MASCC/ASCO Guideline

Mercadante

Jensen

Smith

et al. 2021

JCO

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PURPOSE To provide evidence-based recommendations for prevention and management of salivary gland hypofunction and xerostomia induced by nonsurgical cancer therapies. METHODS Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials published between January 2009 and June 2020. The guideline also incorporated two previous systematic reviews conducted by MASCC/ISOO, which included studies published from 1990 through 2008. RESULTS A total of 58 publications were identified: 46 addressed preventive interventions and 12 addressed therapeutic interventions. A majority of the evidence focused on the setting of radiation therapy for head and neck cancer. For the prevention of salivary gland hypofunction and/or xerostomia in patients with head and neck cancer, there is high-quality evidence for tissue-sparing radiation modalities. Evidence is weaker or insufficient for other interventions. For the management of salivary gland hypofunction and/or xerostomia, intermediate-quality evidence supports the use of topical mucosal lubricants, saliva substitutes, and agents that stimulate the salivary reflex. RECOMMENDATIONS For patients who receive radiation therapy for head and neck cancer, tissue-sparing radiation modalities should be used when possible to reduce the risk of salivary gland hypofunction and xerostomia. Other risk-reducing interventions that may be offered during radiation therapy for head and neck cancer include bethanechol and acupuncture. For patients who develop salivary gland hypofunction and/or xerostomia, interventions include topical mucosal lubricants, saliva substitutes, and sugar-free lozenges or chewing gum. For patients with head and neck cancer, oral pilocarpine and oral cevimeline, acupuncture, or transcutaneous electrostimulation may be offered after radiation therapy. Additional information can be found at www.asco.org/supportive-care-guidelines .

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Randomized controlled study comparing simultaneous modulated accelerated radiotherapy versus simultaneous integrated boost intensity modulated radiotherapy in the treatment of locally advanced head and neck cancer

Abstract: The SMART boost technique can be a feasible alternative fractionation schedule that reduces the overall treatment time, maintaining comparable toxicity and survival compared with SIB-IMRT.

Cited by 2 publications

References 35 publications

Simultaneous Modulated Accelerated Radiotherapy (SMART) with Dysphagia Aspiration-Related Structures (DARS) Sparing: Do We Have a Role for Dose Condensation in Locally Advanced Head and Neck Cancer

Simultaneous Modulated Accelerated Radiotherapy (SMART) with Dysphagia Aspiration-Related Structures (DARS) Sparing: Do We Have a Role for Dose Condensation in Locally Advanced Head and Neck Cancer

Salivary Gland Hypofunction and/or Xerostomia Induced by Nonsurgical Cancer Therapies: ISOO/MASCC/ASCO Guideline

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